HFSA: Heart Failure Origin Affects Cognitive Function

Action Points

Explain to interested patients that three times as many patients with systolic heart failure appear to have memory impairment compared with patients who had diastolic dysfunction.

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Note that performance on tests of attention and executive function did not differ significantly between the two groups.

SAN DIEGO -- Three times as many patients with systolic heart failure appear to have memory impairment compared with patients who had diastolic dysfunction, data from a small cohort study showed.

In the study of 80 older adults, two-thirds of those with systolic dysfunction had evidence of cognitive impairment -- affecting both their immediate and delayed memory. In contrast, only 21% of those patients with diastolic heart failure had memory-related cognitive impairment, according to a presentation here at the Heart Failure Society of America.

However, performance on tests of attention and executive function did not differ significantly between the two groups.

Recent studies have suggested that about half of patients with chronic heart failure have impairment in one or more domains of cognitive function. In most cases, this impairment does not meet diagnostic criteria for dementia -- but can interfere with a patient's ability to process and remember information, said Bauer.

The cognitive domains most often affected by heart failure are attention, memory, and executive function. Whether the type of ventricular dysfunction affects the frequency or nature of cognitive impairment had not been carefully evaluated, as most previous studies focused on patients with systolic dysfunction, said Bauer.

Bauer and colleagues then evaluated the patients' cognitive function by means of a battery of tests that assessed attention, immediate and delayed memory, learning, language, executive function, and psychomotor speed. The type of heart failure (systolic or diastolic) was determined from a chart review.

The results showed significant differences in memory between the two groups.

Patients with systolic dysfunction had a mean score of -1.04 for immediate memory compared with -0.38 for the group with diastolic dysfunction (P=0.01). The averages for delayed memory were -0.72 for the patients with systolic dysfunction and 0.09 for the group with diastolic heart failure (P<0.00).

After controlling for age, sex, ejection fraction, and functional class, patients with systolic dysfunction continued to perform significantly worse on memory tests, including immediate (P=0.03) and delayed memory (P<0.00).

Means scores on Letter Fluency (a test of executive function) were similar between groups.

But the Trail Making Test Part B (also a measure of executive function) was significantly lower in the group with systolic dysfunction, according to an unadjusted analysis (-0.26 versus 0.24, P=0.05). However, after adjustment, the scores between the groups no longer differed significantly.

"These findings require replication in other studies," said Bauer. "Studies are also needed to examine the correlation of cognitive impairment to functional, biological, and genetic markers. Future studies should continue the exploration of the etiological background and trajectory of cognitive impairment in both systolic and diastolic dysfunction heart failure."

Bauer declared that she and her co-investigators had no relevant disclosures.